Justin K Williams, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2305207727 Issued in VA

Practice address

10128 W Broad St
Forum Building III, Suite K
Glen Allen, VA 23060-6761

Phone

(804) 217-9210

Fax

(804) 217-9213

NPI assigned

Nov 1, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tidewater Physical Therapy LLC

  • Physical Therapist
  • Norfolk, VA
  • NPI 1205345444
  NPD (past)
• Tidewater Physical Therapy LLC

  • Physical Therapist
  • Fredericksburg, VA
  • NPI 1427561984
  NPD (past)
• Tidewater Physical Therapy LLC

  • Physical Therapist
  • Salem, VA
  • NPI 1841700432
  NPD (past)
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Virginia Beach, VA
  • NPI 1083133268
  NPD (past)
• Tidewater Physical Therapy, LLC

  • Physical Therapist
  • Charlottesville, VA
  • NPI 1932648649
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1851645543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "771 PILOT HOUSE DR",
            "address_2": "SUITE A",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236061990",
            "telephone_number": "757-873-2302",
            "fax_number": "757-873-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10128 W BROAD ST",
            "address_2": "FORUM BUILDING III, SUITE K",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230606761",
            "telephone_number": "804-217-9210",
            "fax_number": "804-217-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JUSTIN",
        "middle_name": "K",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-01",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305207727",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID QMB",
            "identifier": "1851645543",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PTAN",
            "identifier": "C05954",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edward James Wiley III, MD
• David R Williams III, LPTA
• Elizabeth Rinehardt Williams, P.T.
• Gabrielle Williams, LCSW
• Jacqueline Ann Williams, LPC
• Tadesha Williams
• Taylor Nichelle Williams, RD
• Weston Alberto Williams Jr., RPH
• Brittany Natosha Wilson, BCBA, LBA
• Jazmyn Wilson

• Physical Therapist in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Physical Therapist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.